Section 2000, Programs, Services and Billing

Revision 19-1; Effective November 15, 2019

 

2100 Programs, Services and Billing Codes

Revision 19-1; Effective November 15, 2019

 

The following Medicaid programs and services require a visit transaction for claim reimbursement:

STAR+PLUS STAR Kids STAR Health HHSC Fee-for-Service
  • Personal assistance services (PAS)
  • Personal care services (PCS)
  • Protective Supervision In-home respite services
  • Community First Choice (CFC)-PAS and Habilitation (HAB)
  • PCS
  • In-home respite services
  • Flexible family support services
  • CFC (PCS/HAB)
  • PCS
  • CFC (PAS/HAB)
  • Primary Home Care (PHP)-PAS
  • Community Attendant Services (CAS)-PAS
  • Family Care (FC)-PAS
  • Community Living Assistance and Support Services
    • In-home respite services; and
    • CFC (PAS/HAB)

EVV is optional for consumer directed services (CDS) and service responsibility option (SRO).

For more information regarding CDS options and SRO please refer to Appendix I: Consumer Directed Services Option and Service Responsibility Option.

 

EVV Billing Codes

Below is a list of billing codes for fee-for-service, STAR + PLUS, STAR Kids, and STAR Health programs and services subject to EVV:

 

2200 Resources and Communications

Revision 18-0; Effective November 1, 2018

 

Provider agencies can visit the EVV Training Resources webpage to find information on upcoming trainings, posted training documents and other important announcements. Providers are also encouraged to visit the GovDelivery webpage to sign up and receive HHSC-email alerts regarding EVV and other programs and services required to use EVV.

Providers who have contracts with HHSC are required to sign up for GovDelivery email alerts as outlined in TAC §49.302.

Each MCO has information on their health plan website regarding EVV.

Providers may also visit the Texas Medicaid & Healthcare Partnership (TMHP) website for information regarding EVV.

 

2300 Vendors

Revision 18-0; Effective November 1, 2018

 

EVV vendors include:

HHSC Approved EVV Vendors
DataLogic (Vesta) Software To get started with DataLogic visit their website at www.vestaevv.com.
MEDsys Software Solutions MEDsys contract is expiring on Nov. 6, 2018 and will no longer be an HHSC approved EVV vendor. Due to this contract expiration, MEDsys is not accepting new providers.

 

2400 New Providers

Revision 18-0; Effective November 1, 2018

 

Selecting an EVV Vendor

Fee-for-service provider agencies with new contracts must research and select an HHSC approved EVV vendor no later than 30 calendar days after the effective date of the contract. Provider agencies are only required to select and use one EVV vendor. Provider agencies should visit the EVV vendor’s website to learn more about the vendor’s electronic system or request a system demonstration. The EVV vendor is required to provide system training to provider agencies.

EVV vendors may offer additional software, such as a billing solution, for purchase. Provider agencies are not required to purchase any software or equipment under the HHSC EVV program.

Under the HHSC EVV program, EVV vendor(s) must provide a system allowing a provider agency to enter member information, provider information and service delivery schedules (scheduled or non-scheduled) either through an automated system or a manual system.

Managed care provider agencies:  

For more information on how to get started with EVV by selecting a HHSC approved EVV vendor please visit the “How do I get started with EVV?” section of the HHSC Electronic Visit Verification website.

 

EVV Grace Periods

New contracted fee-for-service provider agencies receive a three month grace period to train staff on how to use the EVV system before being subject to EVV compliance scores.

Provider agencies only receive a single grace period per contract. There is no additional grace period for a provider agency that transitions from one EVV vendor to another. The grace period for HHSC contracted providers ends the last day of the third calendar month after the effective date of the contract. Please see example in the table below:

Effective Day of the Contract EVV Grace Period
Jan. 1 Jan. 1 – Mar. 31
Mar. 1 Mar. 1 – May 31
Aug. 1 Aug. 1 – Oct. 31
Nov. 1 Nov. 1 – Jan. 31

Provider agencies should be using the EVV system during the grace period. Use paper timesheets only for back up purposes during the grace period.

Provider agencies may no longer use paper timesheets to document service delivery beginning on the first day of the fourth calendar month after the effective date of the contract date. If paper timesheets are used to document service delivery on or after this time visits may be subject to recoupment.

Managed care provider agencies:

 

2500 Data Element Requirements

Revision 18-0; Effective November 1, 2018

 

EVV Data Elements

The EVV system requires multiple data elements for electronic verification of the service delivery visit. Enter the following data elements (if applicable) accurately and completely in the EVV system to identify each Visit Data Category in this table.  

Visit Data Category Date Elements
The provider agency:
  • Taxpayer Identification Number (TIN)
  • National Provider Identifier (NPI) or
  • Atypical Provider Identifier (API)
  • Texas Provider Identifier (TPI) (only applicable in Fee for Service)
  • HHS Contract Number(s)
  • Provider Legal Name
  • Provider Address
  • Provider City
  • Provider ZIP Code
Type of service performed:
  • Service Authorization Information
  • Service Group
  • Service Code
  • HCPCS Code
  • Modifiers
The person receiving the service:
  • Last Name
  • First Name
  • Medicaid ID
  • DOB
  • Address, City & Zip Code
  • Landline Phone Number
  • Medicaid Eligibility Start & End
  • Payer
  • Payer Plan Code
  • MCO Service Delivery Area
  • Region (FFS)
  • EVV Client ID (assigned by EVV vendor)
The date and time of the service:
  • Date In
  • Date Out
  • Time In
  • Time Out
The location of service delivery:
  • GPS Coordinates
  • Caller ID
  • Token ID
The person providing the service:
  • Employee Last Name
  • Employee First Name
  • Phone Number
  • EVV Worker ID (assigned by the EVV vendor)
  • Employee Start Date (start date of employment with provider)
  • Employee End Date (end date of employment with provider)

Most data elements are entered once and automatically populate to each service visit. Provider agencies must ensure data elements entered into the EVV system are accurate and complete. Missing or incorrect data elements in the EVV system may result in rejected EVV visit transactions, denied or recouped claims, and inaccurate EVV standard reports.

 

Partial Visit Maintenance Lock Out

The EVV vendor provides a report listing data elements identified as incorrect which cannot be verified against eligibility data. Provider agencies that do not correct missing, incomplete or inaccurate data, will experience a partial lockout of the system. A partial system lockout will prevent agencies from completing visit maintenance until all missing or inaccurate data is corrected in the EVV system. Providers will retain limited system access until all identified data is corrected.